HEENT

Question 1

What can present with painful ulcers and bleeding of the gums and bad breath that is often associated with smoking or a viral infection?

Answer 1

Acute Necrotizing Ulcerative Gingivitis - Vincent’s Disease (trenchmouth)

Question 2

What are the signs/symptoms of acute tonsilitis?

Answer 2

Painful swallowing
Dysphagia
May have fever
Enlarged & tender lymph nodes in upper neck
Throat redness
May have tonsil calculi

Question 3

What is the treatment for bacterial acute tonsilitis?

Answer 3

1st line: amoxicillin
Clindamycin if penicillin allergy

Question 4

What can present with nasal secretion, congestion, facial pressure, & headache?

Answer 4

Acute viral/bacterial rhinosinusitis

Question 5

What is the treatment for acute viral/bacterial rhinosinusitis?

Answer 5

Viral: supportive care with anti-inflammatories, decongestants, fluids
Bacterial: augmentin

Question 6

What are the signs/symptoms of allergic rhinosinusitis?

Answer 6

Clear rhinorrhea
Sneezing
Itchy eyes and throat
Possible swollen turbinates
Eye discharge
Cobblestoning of pharynx
Fluid behind TM
Allergic “shiners”

Question 7

What is the treatment for allergic rhinosinusitis?

Answer 7

Antihistamines

Question 8

What presents with painful, small round lesions w/a red halo and is found on buccal or labial mucosa?

Answer 8

Aphthous ulcers (canker sores)

Question 9

What presents with recurrent episodes of vertigo depending on head movement/position & may have N/V?

Answer 9

Benign Paroxysmal Positional Vertigo (BPPV)

Question 10

How do you test for BPPV?

Answer 10

Check for nystagmus with Dix-Hallpike maneuvers (eyes will move towards affected ear)

Question 11

How do you treat BPPV initially?

Answer 11

Can attempt Epley maneuver
Refer to ENT
Symptomatic relief

Question 12

What commonly presents in infants with URI symptoms such as coughing and weezing?

Answer 12

Bronchiolitis

Question 13

What commonly causes bronchiolitis?

Answer 13

RSV

Question 14

What is the treatment for bronchiolitis?

Answer 14

Supportive care for outpatient non severe cases
Severe cases will likely need hospital admission for respiratory support and fluids

Question 15

How is chronic sinusitis defined?

Answer 15

Infection lasting > 12 weeks

Question 16

What presents with respiratory distress and a “tripod” posture in children, and a severe sore throat, dysphagia, and drooling?

Answer 16

Epiglottitis

Question 17

What diagnostic sign will you see on an x-ray in a patient with epiglottitis?

Answer 17

Thumbprint sign

Question 18

What is the most important thing to do for a patient with confirmed or suspected epiglottitis?

Answer 18

Secure the airway

Question 19

What presents with prolonged malaise (fatigue), tonsil and lymph node enlargement, & possibly tonsil exudate, and what causes it?

Answer 19

Infectious mononucleosis caused by the Epstein-Barr virus

Question 20

How do you treat infectious mono?

Answer 20

Supportive care
Abx if co-infected with strep
Physical limitations due to enlarged spleen
NO AMOXICILLIN due to causing a rash

Question 21

What diagnostic lab can be drawn if you suspect infectious mono?

Answer 21

Monospot rapid test

Question 22

What is the most common cause of croup?

Answer 22

Parainfluenza

Question 23

What are the signs/symptoms of croup?

Answer 23

Seen in younger children
More seen in the winter
Barking cough
Biphasic stridor
URI symptoms

Question 24

What is the treatment for croup?

Answer 24

Mild: supportive care
Mod-Severe: Dexamethasone or nebulized epinephrine

Question 25

What is a complication of acute otitis media that can present with pain, fever, toxicity, fluctuance over mastoid, a prominent pinna, facial paralysis, vertigo, & changes in mental status?

Answer 25

Mastoiditis

Question 26

What is the treatment for mastoiditis?

Answer 26

Empiric IV abx (vanc + metronidazole + cefepime)

Question 27

What is the criteria for diagnosing Meniere disease?

Answer 27

2 or more episodes of vertigo lasting 20 mins - 12 hrs each Low to mid frequency sensorineural hearing loss Fluctuating aural symptoms (hearing loss, fullness, tinnitus)

Question 28

What is the treatment for Meniere disease?

Answer 28

Meclizine/Antivert (25mg TID) Scopolamine patch Diuretics (HCTZ) Low sodium diet Possible endolymphatic shunt

Question 29

What are the signs/symptoms of otitis externa?

Answer 29

Pain Itching Drainage Swelling Hearing loss Erythema

Question 30

What is the treatment for otitis externa?

Answer 30

Mild: acetic acid-hydrocortisone drops Mod: cover for staph and pseudomonas (cipro-hydrocortisone or neomycin-polymyxin B-hydrocortisone) drops Sev: cover for staph and pseudo (same as above), but may need systemic abx Consider wick placement Manage pain

Question 31

What are the signs/symptoms of otitis media?

Answer 31

Pain Fever Irritability Purulent drainage Hearing loss URI symptoms

Question 32

What diagnostic test can be performed when assessing for otitis media?

Answer 32

Tympanic mobility test (pneumatic otoscopy)

Question 33

What is the first line treatment for otitis media?

Answer 33

Augmentin

Question 34

What should be considered in children with frequent otitis media infections?

Answer 34

Myringotomy tubes

Question 35

What is the treatment for a perforated TM?

Answer 35

Small: most close on their own Large: ENT referral

Question 36

What can present with fever, sore throat, trismus (can't open mouth), muffled voice; may have unilateral symptoms, bulging tonsil, & uvular deviation?

Answer 36

Peritonsillar abscess

Question 37

What is the treatment for a peritonsillar abscess?

Answer 37

I&D Possibly tonsillectomy & antibiotics Can be life threatening if it blocks airway

Question 38

What are most cases of pharyngitis caused by and what is the treatment?

Answer 38

Most caused by virus and do not require abx (supportive care)

Question 39

What can present with headache, earache, & pain aggravated by jaw movement?

Answer 39

TMJ

Question 40

What is the treatment for TMJ?

Answer 40

NSAIDS Soft diet Heat/massage Dental referral